Discontinuation of anticoagulant care during admission to a psychiatric hospital
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Discontinuation of anticoagulant care during admission to a psychiatric hospital H. Abdullah-Koolmees & T. Gerbranda & V. H. M. Deneer & M. M. Tjoeng & A. J. M. De Ridder & H. Gardarsdottir & E. R. Heerdink
Received: 18 June 2012 / Accepted: 30 August 2012 / Published online: 23 October 2012 # Springer-Verlag 2012
Abstract Purpose Continuation of coumarin therapy is important to prevent thromboembolic events. Continuation of medication, unrelated to the reason for hospital admission, may be at risk due to the patient’s psychiatric status and the involvement of several physicians in patient care. Methods We performed a retrospective follow-up study of users of orally administered anticoagulants who were admitted to a psychiatric hospital. Information on patient characteristics, anticoagulant use, and International Normalized H. Abdullah-Koolmees : T. Gerbranda : E. R. Heerdink Department of Clinical Pharmacy, Altrecht Institute for Mental Healthcare, Den Dolder, The Netherlands H. Abdullah-Koolmees : H. Gardarsdottir : E. R. Heerdink (*) Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, David de Wied building, PO Box 80082, 3508 TB Utrecht, The Netherlands e-mail: [email protected] T. Gerbranda Department of Clinical Pharmacy, VU Medical Centre, Amsterdam, The Netherlands T. Gerbranda : V. H. M. Deneer : M. M. Tjoeng Department of Clinical Pharmacy and Pharmacology, St. Antonius Hospital, Utrecht & Nieuwegein, Nieuwegein, The Netherlands A. J. M. De Ridder Department of Elderly Psychiatry, Altrecht Institute for Mental Healthcare, Zeist, The Netherlands H. Gardarsdottir : E. R. Heerdink Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
Ratio (INR) measurements was collected. Discontinuation of anticoagulant care was defined as no anticoagulant dispensing during the first 7 days of hospitalization and/or no INR measurement during hospitalization. Relative risks (RR) of discontinuation, overall and stratified by patient characteristics, was estimated using Cox regression analysis. Results Of 111 patients, 24.3 % had their anticoagulant care discontinued. For 17.1 %, no anticoagulant was dispensed during the first week, and 13.5 % had no INR measurement during hospitalization. Conclusions Admission to a psychiatric hospital leads to discontinuation of anticoagulant care in 24.3 % of patients, with highest risk of discontinuation in patients admitted to nonpsychogeriatric wards. More research is needed to evaluate the clinical impact of this finding. Keywords Anticoagulants . Acenocoumarol . Phenprocoumon . Discontinuation . Psychiatric hospital . Somatic care
Introduction Change of healthcare setting often leads to changes in pharmacotherapy [1–3]. Stuffken et al. found that in 63.1 % of hospitalized patients, one or more medications are changed, of which stopping the medication was the most frequent (55.2 %). Medication changes can be intentional, but lac
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